Jánoskuti L, Lengyel M, Fenyvesi T
III Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
Heart. 2004 May;90(5):e27. doi: 10.1136/hrt.2003.031633.
A case of pericardial actinomycosis mimicking a pericardial tumour is reported. After the appearance of non-specific subpleural pulmonary nodules, a 48 year old woman presented with fever and clinical signs of pericardial tamponade. Subxiphoid pericardiotomy yielded a culture negative fluid and inflammatory reactive histopathology in the pericardial biopsy specimen. Because of suspected infection cefamandole was administered for 10 days and the patient became afebrile. The pericardial effusion recurred with no clinical signs two weeks later. Steroid medication resulted in rapid regression of the pericardial effusion. Subsequent echocardiography controls showed a tumour-like pericardial mass, confirmed by cardiac magnetic imaging. Surgical exploration led to the final histological diagnosis of actinomycosis. After high dose and long term penicillin G treatment the patient recovered fully with no recurrence during two years' follow up.
本文报告了一例疑似心包肿瘤的心包放线菌病病例。一名48岁女性在出现非特异性胸膜下肺结节后，出现发热及心包填塞的临床症状。剑突下心包切开术抽出的液体培养结果为阴性，心包活检标本的组织病理学显示为炎症反应。由于怀疑感染，给予头孢孟多治疗10天，患者体温恢复正常。两周后心包积液复发，但无临床症状。使用类固醇药物后心包积液迅速消退。随后的超声心动图检查显示心包有肿瘤样肿块，心脏磁共振成像得以证实。手术探查最终确诊为放线菌病。经过大剂量长期青霉素G治疗，患者完全康复，随访两年无复发。
